The work-injury allowance claim form is intended for an
employee and a self-employed person who have been injured at work as a result
of a work-related accident. The form is also intended for a volunteer who was
injured during his or her volunteer activities. In this form you can also
submit a request for recognition of an occupational disease or medical
disability resulting from working conditions.
Please note that in case of Novel
Coronavirus contamination in the workplace:
The form must be completed as a
"work-related accident" and not as an occupational disease,
and a questionnaire on Novel Coronavirus contamination must be attached to the claim
(Employer – BTL/257, Employee – BTL/258, Self-employed – BTL/259).